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Myotrauma in mechanically ventilated patients

  • Ewan C. GoligherEmail author
Understanding the Disease
In 1988, Knisely et al. “noted marked thinning of the muscular portions of the diaphragm” in neonates following prolonged mechanical ventilation [ 1]. This provided the first evidence that adverse patient–ventilator interactions can cause deleterious structural changes in the diaphragm, a phenomenon recently termed myotrauma [ 2]. Extensive experimental and clinical investigation has confirmed the existence of myotrauma and characterized its prevalence and clinical impact [ 2, 3]. Diaphragm myotrauma is a serious concern because it leads to acute diaphragm weakness (referred to as ventilator-induced diaphragm dysfunction; see Table 1 for terminology) and can therefore impair patients’ ability to be liberated from mechanical ventilation. Prolonged mechanical ventilation predisposes patients to nosocomial complications and strongly predicts long-term morbidity and mortality [ 4]. Preventing myotrauma might therefore accelerate liberation from mechanical ventilation and significantly improve...

Notes

Acknowledgements

The author thanks Thomas Piraino, RRT, and Laurent Brochard, MD, for helpful suggestions on this manuscript.

Compliance with ethical standards

Conflicts of interest

Dr. Goligher’s laboratory has received non-financial support in the form of equipment from Getinge and GE. Dr. Goligher reports receiving speaking honoraria from Getinge.

Ethical approval

An approval by an ethics committee was not applicable.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  2. 2.Department of Medicine, Division of RespirologyUniversity Health NetworkTorontoCanada
  3. 3.Toronto General Hospital Research InstituteTorontoCanada

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